The Relationship of Olecranon Apophyseal Ossification and Sanders Hand Scores with the Timing of Peak Height Velocity in Adolescents

Abstract

Background:The onset of peak height velocity (PHV) guides the timing of interventions in the growing child. The purpose of the present study was to validate the Diméglio olecranon grading system and to compare these scores with the Risser/triradiate closure (TRC), proximal humerus, and Sanders hand scores.Methods:Eighty children with annual serial radiographs were selected from the Bolton-Brush collection. The olecranon apophysis was graded with use of lateral radiographs of the elbow. The mean age to PHV was determined for each stage, and reliability was calculated with use of an intraclass correlation coefficient (ICC). Olecranon stage was combined with age, sex, and height in a generalized estimating equation (GEE) model to predict PHV. Predictive performance of this model was evaluated with use of tenfold cross-validation such that the model was trained on 90% of the radiographs and was asked to predict the PHV of the remaining 10%.Results:PHV is closely associated with olecranon stage, with stage 1 occurring 3.0 years before PHV and stage 7 occurring 3.4 years after PHV. Stage 5 was found to occur at PHV. Scoring system reliability was high across an array of observers (ICC = 0.85 ± 0.07). The GEE model showed that this olecranon system outperforms the Risser/TRC system in predicting PHV and is comparable with the humerus and Sanders hand systems. When combined with age and sex, the olecranon system successfully predicted PHV such that 62% of PHV predictions were accurate within 6 months and 90% of PHV predictions were accurate within a year.Conclusions:Our data show that stage 5 occurs at PHV, contrary to previously published data. When combined with age and sex, the olecranon system successfully predicts PHV within a year in 90% of cases, establishing a single lateral view of the olecranon as a simple alternative to more complex grading systems. Last, we describe novel 3 variations in olecranon morphology and provide a guide for accurate olecranon staging.Clinical Relevance:Understanding PHV is critical in the treatment of many pediatric orthopaedic disorders. The revised olecranon staging system will allow for more accurate determination of this variable.

Using Skeletal Maturity in Pediatric Orthopaedics: A Primer

“…15 Upon validation, it was determined that PHV occurs at stage 5 of this system rather than stage 7 as was originally described, illustrating the importance of using longitudinal datasets when developing skeletal maturity systems. 15 Regardless, the olecranon apophyseal ossification system was found to have utility in identifying risk of progression to a surgical curve ( > 45 degrees) in scoliosis. In a cohort of primarily braced patients, Charles et al 13 found that adolescent idiopathic scoliosis patients at the "half-moon stage" (best correlates with stage 5) with a curve of 21 to 30 degrees had 72.5% chance of progression to a surgical curve, whereas those with a curve of > 30 degrees had 100% chance of progression (Elbow Primer, Supplemental Digital Content 3, http://links.lww.com/BPO/A481; Elbow Practice Radiographs, Supplemental Digital Content 4, http://links.lww.…”

“…To produce its skeletal maturity output, the modified Fels knee system requires the following inputs: chronological age, sex, and evaluation of 7 parameters identifiable on AP knee radiograph (Knee Primer, Supplemental Digital Content 9, http://links.lww.com/BPO/A487; Knee Practice Radiographs, Supplemental Digital Content 10, http://links.lww. 23 Please refer to the supplemental materials for in-depth instruction and examples of how to use this skeletal maturity system. Reprinted with permission from Greene et al 23 Copyright The Journal of Bone and Joint Surgery Inc., Needham, MA.…”

“…23 Please refer to the supplemental materials for in-depth instruction and examples of how to use this skeletal maturity system. Reprinted with permission from Greene et al 23 Copyright The Journal of Bone and Joint Surgery Inc., Needham, MA. All permission requests for this image should be made to the copyright holder.…”

“…Schematic of the olecranon apophyseal ossification system stages. Peak height velocity (PHV) is typically reached at stage 5 23. Please refer to the supplemental materials for in-depth instruction and examples of how to use this skeletal maturity system.…”

“…More recently, Dimeglio simplified the Sauvegrain system by focusing on only the olecranon apophysis; this simplification has become the predominant way skeletal maturity is evaluated at the elbow 3. A major drawback of both these systems was their lack of validation on a longitudinal dataset, an issue recently addressed for the Dimeglio system by Greene et al15 Another longstanding method of skeletal maturity estimation is the combination of Risser staging and triradiate cartilage closure. The major advantage of this system is its convenience in scoliosis treatment: the iliac crest and triradiate cartilage are nearly always present in scoliosis films 16.…”